This article was downloaded by: [University of North Texas] On: 03 December 2014, At: 07:29 Publisher: Routledge Informa Ltd Registered in England and Wales Registered Number: 1072954 Registered office: Mortimer House, 37-41 Mortimer Street, London W1T 3JH, UK
Journal of American College Health Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/vach20
Beliefs About Meditating Among University Students, Faculty, and Staff: A Theory-Based Salient Belief Elicitation a
a
Alyssa M. Lederer MPH, CHES & Susan E. Middlestadt PhD a
Department of Applied Health Science, Indiana University School of Public Health–Bloomington, Bloomington, Indiana Accepted author version posted online: 17 Apr 2014.Published online: 15 Aug 2014.
To cite this article: Alyssa M. Lederer MPH, CHES & Susan E. Middlestadt PhD (2014) Beliefs About Meditating Among University Students, Faculty, and Staff: A Theory-Based Salient Belief Elicitation, Journal of American College Health, 62:6, 360-369, DOI: 10.1080/07448481.2014.907296 To link to this article: http://dx.doi.org/10.1080/07448481.2014.907296
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JOURNAL OF AMERICAN COLLEGE HEALTH, VOL. 62, NO. 6
Major Article
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Beliefs About Meditating Among University Students, Faculty, and Staff: A Theory-Based Salient Belief Elicitation Alyssa M. Lederer, MPH, CHES; Susan E. Middlestadt, PhD
Abstract. Objective: Stress impacts college students, faculty, and staff alike. Although meditation has been found to decrease stress, it is an underutilized strategy. This study used the Reasoned Action Approach (RAA) to identify beliefs underlying university constituents’ decision to meditate. Participants: N D 96 students, faculty, and staff at a large midwestern university during spring 2012. Methods: A survey measured the RAA global constructs and elicited the beliefs underlying intention to meditate. Thematic and frequency analyses and multiple regression were performed. Results: Quantitative analyses showed that intention to meditate was significantly predicted (R2 D .632) by attitude, perceived norm, and perceived behavioral control. Qualitative analyses revealed advantages (eg, reduced stress; feeling calmer), disadvantages (eg, takes time; will not work), and facilitating circumstances (eg, having more time; having quiet space) of meditating. Conclusions: Results of this theory-based research suggest how college health professionals can encourage meditation practice through individual, interpersonal, and environmental interventions.
college students nationally, with 27.5% reporting that stress had negatively impacted their academic performance in the last 12 months.1 Although there is no equivalent widereaching survey for university employees, studies at individual campuses have shown that faculty and staff also report that stress leads to negative outcomes in their personal and professional lives,5–7 and literature has shown that stress and poor health negatively impact work performance.4,8,9 Given the problematic outcomes, Healthy Campus 2020 calls for college health professionals to help students and employees decrease their stress levels.10 Meditation is considered a mind–body practice within the sphere of complementary and alternative medicine (CAM). Although it originated in the East, meditation is increasingly recognized as a strategy to improve health and well-being in the United States.11 Meditation has been shown to improve mental and physical health and enhance quality of life.12,13 Further, meditation has been found to specifically reduce stress among college students14–17 and employees.18,19 Additionally, there is emerging evidence that meditation may have a positive impact on students’ academic outcomes.20–22 Although meditation programs are an emerging practice in higher education,23 many institutions struggle with recruitment and attendance (H. Zesiger, personal communication, July 26, 2012), as they have with other wellness programs.24 This is particularly problematic given that these programs can only be efficacious and cost-effective if attendance is sufficiently high. At the national level in 2007, only 9.4% of US adults reported practicing meditation at least once in the past 12 months,11 and it is likely that far fewer maintain a regular practice. Although the impact of meditation is well studied,25,26 little is known about the beliefs underlying individuals’ decisions to meditate. Since “it is at the level of beliefs that we obtain substantive information about the considerations
Keywords: beliefs, college students, employees, meditation, reasoned action approach
S
tress is a pervasive problem in American society, and university communities are no exception. In 2011, 53.1% of college students reported an above average level of stress,1 and university faculty reported persistent work-related and other stressors.2 Stress has been linked to increased smoking, lack of exercise and sleep, depression, cardiovascular disease, and decreased medication adherence.3,4 Further, stress is associated with problematic academic and work outcomes. Stress was identified as the number 1 impediment to academic success for Ms Lederer and Dr Middlestadt are with the Department of Applied Health Science at Indiana University School of Public Health–Bloomington in Bloomington, Indiana. Copyright Ó 2014 Taylor & Francis Group, LLC 360
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Beliefs About Meditating Among University Constituents
that lead people to perform, or not to perform, a given behavior,”27(p204) effective intervention design rests on understanding these determinants.28 Thus, if college health professionals want to increase the number of people who meditate, the factors that influence meditation practice must be determined. This study sought to identify the salient, top-of-the-mind beliefs held by university students, faculty, and staff about meditating at least once per week for the next 3 months. The study included all campus constituents given the emerging trend in college health to view all members of a college campus as a community.10,29 The study was based on the Reasoned Action Approach (RAA), which has been used successfully to investigate decision making for a variety of behaviors.27 According to the RAA, behavior is principally determined by intention. Intention is, in turn, influenced by 3 global constructs: attitude towards the act, perceived norm, and perceived behavioral control, also known as self-efficacy. The 3 global constructs are grounded in underlying salient (top-of-the-mind) beliefs. Attitude is based on beliefs about the salient consequences of engaging in the behavior. Perceived norm is based on beliefs about what salient social referents (ie, people or social groups who have influence) think. Perceived behavioral control is influenced by beliefs about the salient circumstances that facilitate or hinder the behavior. A critical step in using the RAA to design interventions is an elicitation to identify salient consequences, referents, and circumstances that form the belief structure of the behavior.30 In this study, open-ended questions were asked of a sample of university students and employees to identify the most frequently mentioned beliefs about meditating at least once a week for the next 3 months. Because some studies have examined daily meditation and others have examined meditation once a week, the frequency of meditating at least once a week was selected for this initial study given the focus of ultimately encouraging people to begin a meditation practice. To the authors’ knowledge, this is the first study to explore the belief structure underlying deciding to meditate. METHODS A survey was conducted in spring 2012 with a convenience sample of students, faculty, and staff at a large midwestern public university.
Procedure The study was approved by the researchers’ institutional review board. Following the procedures developed and validated by Fishbein and Ajzen,27 the instrument developed for the study was piloted with 13 graduate students to confirm its timing, understandability, and feasibility. Minor revisions were made and the revised instrument was converted into the Web-based survey program Qualtrics (Provo, Utah). Students, faculty, and staff were recruited through e-mail requests, announcements in courses, wordVOL 62, AUGUST/SEPTEMBER 2014
of-mouth, and flyers at community locales frequented by university members (eg, coffee shops, restaurants). All recruitment materials provided a link to the online survey. No incentives were offered. Because a salient belief elicitation should consist of roughly equal numbers of participants who do and do not practice the behavior,30 recruitment efforts also targeted venues that were perceived as more likely to host people who meditate, such as a communitybased meditation center and yoga studios. To increase the sample size, a hard copy of the survey was distributed in an undergraduate health course. These data were then manually entered into Qualtrics. The only inclusion criteria were being 18 years or older and being a student, faculty, or staff member at the university.
Instrument The survey instrument began with an informed consent statement and consisted of 42 questions with 4 sections: (1) open-ended questions to elicit salient beliefs, (2) closedended questions measuring the RAA global constructs, (3) questions assessing meditation practice, and (4) items related to demographic and other participant characteristics. The survey took approximately 15 minutes to complete. The RAA variables were for the behavior of “meditating at least once per week for the next three months.” The behavior referred to meditation broadly given the subjective nature of meditation, its numerous forms, and in an effort to reach the widest possible audience. To ensure participants understood the study definition of meditation, the following description was provided: Meditation is generally seen as an inwardly oriented, personal practice, which individuals can do by themselves. Meditation refers to the actions involved in quieting the mind and body to allow one to become aware of the self. Meditation may involve cultivating a feeling or internal state or attending to a specific focal point or following the breath. The term can refer to the state itself as well as to practices or techniques employed to cultivate the state. Meditation can take various forms, including mindfulness, transcendental, movement, mantra, and spiritual meditation. For some, meditation is a religious or spiritual practice; for others it is a wellness practice.
Six open-ended questions elicited salient beliefs: 2 about consequences (ie, “What are the advantages or good things that might happen if you meditate at least once per week for the next three months?” and “What are the disadvantages or bad things that might happen. . .?”), 2 about social referents (ie, “Who, which people or groups, might approve or support you if you meditate at least once per week for the next three months?” and “Who, which people or groups, might disapprove . . .?”), and 2 about circumstances (ie, “What might make it easier for you to meditate at least once per week for the next three months?” and “What might make it hard for you . . .?”). Participants were asked to list 1 to 3 salient, top-of-the-mind responses for each question. 361
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Closed-ended RAA constructs were assessed with items using 7-point semantic differential or agree/disagree response options. Two items measured intention: (1) “My meditating at least once a week for the next three months is [likely/unlikely]” and (2) “I will meditate at least once a week for the next three months [strongly agree/strongly disagree].” Attitude was assessed by 4 items: “My meditating at least once a week for the next three months is [(1) good/bad; (2) enjoyable/unenjoyable; (3) wise/foolish; (4) pleasant/unpleasant].” Perceived norm was assessed with 3 items: (1) “Most people who are important to me think I should meditate at least once a week for the next three months [strongly agree/strongly disagree]”; (2) “Most people like me will meditate at least once a week for the next three months [strongly agree/strongly disagree]”; and (3) “How many people similar to you meditate at least once a week? [virtually all/almost none].” Perceived behavioral control was measured with 3 items: (1) “My meditating at least once a week for the next three months is [under my control/not under my control]”; (2) “How confident are you that you can meditate at least once a week for the next three months? [completely confident/not at all confident]”; and (3) “How sure are you that you can meditate at least once a week for the next three months? [very sure/not at all sure].”
Analysis Qualtrics data were exported into SPSS version 19.0 (IBM, Armonk, New York). Four cases were dropped because of missing quantitative data for the RAA constructs. The closed-ended items measuring the global constructs were recoded from 1 to 7 to ¡3 to C3. Reliability analyses confirmed a 2-item measure of intention (Cronbach’s a D .941), a 4-item measure of attitude (a D .911), a 3-item measure for perceived norm (a D .704), and a 3-item measure for perceived behavioral control (a D .783). The items for intention, attitude, perceived norm, and perceived behavioral control were then averaged to create a combined scale for each construct. Standard multiple regression analysis predicted intention from the 3 global constructs. Evaluating the assumptions of regression, including adequate sample size, normality, linearity, homoscedasticity of residuals, absence of outliers, and absence of singularity and multicollinearity31 resulted in deleting 1 case that was identified as a univariate outlier. At this point, all of the assumptions of regression were met. A content analysis was conducted of the responses to the open-ended questions to create categories of similar responses. Responses were reviewed verbatim and grouped by consequences (advantages and disadvantages of meditation), referents (people who approve and disapprove of meditation), and circumstances (what makes it easy and hard to meditate).30 Individual responses were listed within each category, and those that were conceptually similar were combined by A. M. L. (first author) who has 2 years of experience using the RAA and several years of 362
experience with qualitative analysis. S. E. M. (second author), who has over 30 years of experience with theorydriven research and qualitative coding, then reviewed the analyses and any areas of disagreement were discussed until consensus was reached. Responses within each category were listed in the order of the most common responses and each category was then labeled in the words of the participants. The data in the form of mentioned/not mentioned variables for each of the thematic categories were merged with the closed-ended data and frequency analyses were conducted to determine the most salient categories. Interrater agreement with a third researcher trained in the RAA using the kappa statistic was used to assess the reliability of the coding. More specifically, responses to all 6 questions, representing 25% of the cases and 369 individual responses selected at random, were coded by a second researcher familiar with conducting an RAA elicitation. The resultant kappa of 0.910 indicated a high level of agreement.32 RESULTS Participants The final sample size was N D 96, which included 72 participants from the online survey and 24 participants from the hard copy survey. As shown in Table 1, there was representation from diverse realms of university life, including undergraduate students, graduate students, faculty, and staff members. Most participants were under the age of 34 and identified as Caucasian. The vast majority reported a high level of concern with wellness and most were moderately or slightly spiritual.
Predisposition to Meditate Although 85.4% (n D 82) of participants had tried meditating at some point in their lives, 35.4% (n D 14) reported meditating at least once in the 7 days prior to the survey. From Table 2, it can be seen that although the participants had a positive attitude toward meditating at least once a week (M D 1.77 on a ¡3 to C3 scale), overall their intention was neutral (M D ¡0.182), showing neither a negative nor a positive intention to meditate. Perceived behavioral control was slightly positive (M D 0.903), whereas perceived norm was slightly negative (M D ¡0.361). Predicting Intention to Meditate As shown in Table 3, each global construct (attitude, perceived norm, and perceived behavioral control) had a moderate positive bivariate Pearson correlation (p < .001) with intention to meditate at least once per week for the next 3 months. The combination of the 3 global constructs significantly predicted intention to meditate (F[3, 95] D 52.692, p < .001). An R2 of .632 means that the 3 global constructs account for 63.2% of the variance in intention. All 3 constructs had statistically significant regression weights with perceived behavioral control making the largest JOURNAL OF AMERICAN COLLEGE HEALTH
Beliefs About Meditating Among University Constituents
contribution (b D .471, p < .001), then attitude (b D .354, p < .001), and then perceived norm (b D .191, p < .05).
TABLE 1. Participant Characteristics
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Characteristic University status Undergraduate Graduate Faculty Staff Sex Female Male Race/Ethnicity White/Caucasian Black or African American Latino or Hispanic Asian or Asian American Multiracial Other Age 18–24 25–34 35–44 45–54 55C Spirituality Very Moderately Slightly Not at all Concerned with wellness Very Moderately Slightly Not at all Meditation experience Ever tried In last 7 days
n
%
42 29 9 15
44.3 30.6 9.8 15.8
67 27
71.3 28.7
79 5 2 3 2 3
84.0 5.3 2.1 3.2 2.1 3.2
38 26 12 10 9
40.0 27.0 12.6 10.5 9.5
18 41 24 12
18.9 43.8 25.3 12.6
45 40 8 2
47.4 42.1 8.4 2.1
82 14
85.4 35.4
Salient Consequences Underlying Attitude Component Table 4 shows the salient, top-of-the-mind consequences, both positive and negative, about meditating at least once per week for the next 3 months. The most common advantage given was will reduce my stress (59.4%, n D 57), with responses such as “less stress” and “less anxiety.” This was followed by will make me calmer (50.0%, n D 48), which included responses such as “more calm,” “relaxation,” and “more peaceful.” Next was will make me more focused (39.6%, n D 38), which related to having more focus, having a clearer mind, and increased productivity. For example, 1 participant wrote “help you work more efficiently.” Participants also felt that meditating would make them more self-aware (30.2%, n D 29), with responses such as “know myself better” and “gain insights.” Participants also believed that meditation would improve my health (27.1%, n D 26). Although in most cases participants referred to health in general (eg, “better health”), some participants mentioned specific health outcomes (eg, “lower blood pressure,” “better sleep,” and “breathe better”). The most common disadvantage was it will take time (53.1%, n D 51). Many participants (31.3%, n D 30) were concerned that meditation will not work, giving answers such as “no actual benefits” and “frustration over lack of results.” Some participants believed that it was possible they will get too into it (10.4%, n D 10) or will get made fun of (9.4%, n D 9). A few participants were concerned it will make me think about uncomfortable things (7.3%, n D 7), such as “confront disturbing memories,” or that meditation could change the type of person I am (7.3%, n D 7), such as “inflated sense of self-importance.” Thirty
Note. Because some participants did not answer all questions, n does not add to 96 for every characteristic.
TABLE 2. Global Construct Scale Characteristics (N D 96) Scale
Items
a
M
SD
2 4 3 3
0.941 0.911 0.704 0.783
¡0.182 1.766 ¡0.361 0.903
2.01 1.23 1.28 1.58
Intention Attitude Perceived norm Perceived behavioral control
TABLE 3. Predictors of Intention to Meditate at Least Once per Week for the Next 3 Months (N D 96) Predictor variable Attitude Perceived norm Perceived behavioral control
Pearson r ***
.575 .601*** .666***
B
SE B
b
p
0.575 0.300 0.600
0.117 0.126 0.094
0.354 0.191 0.471
< 0.001*** 0.02* < 0.001***
Note. R2 D .632. * p < .05; **p < .01; ***p < .001.
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TABLE 4. Salient Consequences of Meditating at Least Once per Week for the Next 3 Months
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Consequence Advantages Meditating at least once per week for the next 3 months . . . (N D 96) Will reduce my stress Will make me calmer Will make me more focused Will make me more self-aware Will improve my health Will make me happier Will give me balance Will give me more patience Disadvantages Meditating at least once per week for the next 3 months . . . (N D 96) Will take time Will not work Will get too into it Will get made fun of Will make me think about uncomfortable things Will change the type of person I am None
n
%
57 48 38 29 26 15 13 11
59.4 50.0 39.6 30.2 27.1 15.6 13.5 11.5
51 30 10 9 7 7 29
53.1 31.3 10.4 9.4 7.3 7.3 30.2
Note. Percentages sum to more than 100%, since participants could list multiple answers.
percent of participants either wrote that there were no disadvantages to meditating or listed no disadvantages. Salient Circumstances Underlying Control Component Table 5 lists the salient, top-of-the-mind facilitators and barriers of meditating with the facilitator phrasing on the left and the barrier phrasing on the right. Time was the most frequently mentioned circumstance: 50% (n D 48) mentioned having more time as a facilitator and 83.3% (n D 80) said that having other things to do was a barrier. “Not enough time” and “busy schedule” were typical responses. Many were concerned with having a place to
meditate. About one-third of participants mentioned that having a quiet place would make meditation easier; about one-third indicated that not having a quiet place would make meditation more difficult. Some participants provided tactics for overcoming this barrier. For example, one participant suggested “the option of locking the office door, or study room door.” Participants felt that having guidance (27.1%, n D 26), which consisted of responses such as “training/education on how to meditate,” “learning how to do it,” and “guidance from someone” would help them to meditate. A few (9.4%, n D 9) mentioned not knowing how would make meditating more challenging. Not being able to relax (16.7%, n D 16)
TABLE 5. Salient Circumstances for Meditating at Least Once per Week for the Next 3 Months Salient circumstances Facilitators . . . makes it easier to me to meditate at least once per week for the next 3 months (N D 96) Having more time Having a quiet place Making it part of my schedule Having guidance Having people to do it with Practicing a specific technique Feeling supported Making a commitment Having patience Seeing the benefits
n
48 37 33 26 19 11 9 8 7 6
%
50.0 38.5 34.4 27.1 19.8 11.5 9.4 8.3 7.3 6.3
Barriers
n
%
. . . makes it difficult for me to meditate at least once per week for the next 3 months (N D 96) Having other things to do Not having a quiet space Having an irregular schedule Not knowing how
80 33 9 9
83.3 34.4 9.4 9.4
10 11 16 5 8
10.4 11.5 16.7 5.2 8.3
Not feeling supported Not being motivated Not being able to relax Not thinking it will work Having health problems
Note. Percentages sum to more than 100%, since participants could list multiple answers.
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was also an obstacle to meditation among participants, whereas 7.3% (n D 7) reported that having more patience would make meditating easier. Support or lack thereof was mentioned as a facilitator (9.4%, n D 9) and a barrier (10.4%, n D 10), respectively. Responses ranged from specific support systems such as “people at home who supported it” to wide-ranging social norms with responses such as “if it was socially normal.” Participants reported several overall strategies to facilitate their meditation practice, such as having people to do it with (19.8%, n D 19) and practicing a specific technique (11.5%, n D 11). Many participants (34.4%, n D 33) reported that making it part of my schedule would help them to meditate. This category included strategies like “setting a regular time,” “waking up earlier,” “time given in class,” and “time given at work.”
Salient Referents Underlying Normative Component As seen in Table 6, friends (52.1%, n D 50) and family (51.0%, n D 49) were the most frequently mentioned referents who would approve of meditating. Many participants listed family in general without reference to a specific family member. Several (19.8%, n D 19) thought that significant others, consisting of spouses, fiances, boyfriends, and girlfriends, would approve. People associated with various institutions (41.7%, n D 40) were also listed as approving of meditating. These included people affiliated with health care (16.7%, n D 16), which consisted of both medical and mental health professionals; religion (16.7%, n D 16), such as “Buddhists,” “religious leaders,” and “church”; university (9.4%, n D 9), which included faculty members, advisors, and coaches; and yoga (6.3%, n D 6) instructors and
practitioners. People who believe in meditation (15.6%, n D 15) were also thought to approve, with responses such as “other people who meditate” and “hippies.” The majority of participants (59.4%, n D 57) believed no one would disapprove of their meditating. Of those referents perceived as disapproving, family (13.5%, n D 13) and religion (10.4%, n D 10) were listed most frequently. COMMENT This study applied the RAA to identify the behavioral, normative, and control beliefs underlying university students’, faculty’s, and staff members’ decision to practice meditation at least once per week for the next 3 months. This research should prove valuable for 2 primary reasons. First, despite the evidence on the benefits of meditation, beliefs about meditating have not been investigated. The research presented begins to fill this gap. Second, this study was guided by a theory-based approach, which increases the likelihood that interventions developed using these findings will be successful.33 Although additional quantitative research with a larger sample is necessary to confirm these preliminary findings about beliefs about meditation, the results can provide a number of suggestions for interventions and programs to encourage meditation on college campuses and beyond. As such, recommendations for intervention design will be provided along with a discussion of the major findings below. The large majority of participants had tried meditation at least once and about one-third had meditated in the last 7 days. Participants had a positive attitude and somewhat positive sense of control over deciding to meditate, but their intention was neutral. This finding implies that meditation is a feasible intervention in this setting but efforts must be
TABLE 6. Salient Referents for Meditating at Least Once per Week for the Next 3 Months Salient referents Approving referents . . . approves of me meditating at least once per week for the next 3 months (N D 96) Significant other Family Family Sibling Parents Child Friends Coworkers People at institutions Health care Religion University Yoga People who believe in meditation
n
19 49 32 2 11 4 50 15 40 16 16 9 6 15
%
19.8 51.0 33.3 2.1 22.5 4.2 52.1 15.6 41.7 16.7 16.7 9.4 6.3 15.6
Disapproving referents
n
%
. . . disapproves of me meditating at least once per week for the next 3 months (N D 96) Significant other Family Family
3 13 7
3.1 13.5 7.0
Parents Child Friends Coworkers People at institutions Health care Religion University
3 4 6 4 13 2 10 1
3.1 4.2 6.3 4.2 13.5 2.1 10.4 1.0
People who don’t believe in meditation None
11 57
11.5 59.4
Note. Percentages sum to more than 100%, since participants could list multiple answers.
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made to increase individuals’ intention to meditate. Given this, campus health professionals should consider offering meditation programs for students, faculty, and staff, particularly with the forthcoming recommendations in mind. This programming should be practicable, as literature has shown that relaxation interventions such as meditation are one of the more easily implemented types of stress reduction programs that health promotion professionals can offer.34 Additionally, this collective approach may further efforts to cultivate a culture of health and community on campus. The R2 of 63.2% indicates that almost two-thirds of the variation in intention to meditate is explained by the 3 global constructs. This is somewhat larger than the average of 44.3% identified in a meta-analysis by McEachan and colleagues35 of over 200 studies related to multiple health behaviors. This finding demonstrates that the RAA is useful with this behavior for the campus population. Although all 3 global constructs had statistically significant regression weights, perceived behavioral control had the highest weight, then attitude, and the normative component weight was the lowest. This is somewhat consistent with the McEachen et al35 meta-analysis that found high mean regression weights for attitude (b D .35) and for perceived behavioral control (b D .34) and a low average weight for norm (b D .15). Interestingly, in a study using the theory of planned behavior to identify beliefs about yoga, another CAM practice, the same ranking of constructs was found as in the present study.36 The finding on the size of the weights implies that efforts to increase university constituents’ meditation practice should first focus on perceived behavioral control and then on attitude. Although the details on specific implications for practice require an analysis of specific beliefs and will be described in detail below, at this point, it should be noted that increasing a sense of control could be accomplished in 2 ways. On the one hand, college health professionals could make the campus environment more conducive to meditation through a variety of physical, social, organizational, and policy changes. On the other hand, professionals could also aid constituents in building their self-efficacy in order to overcome the barriers in the environment. The salient belief elicitation revealed the salient or topof-the-mind perceived consequences, circumstances, and referents that may influence university students and employees’ decision to meditate. Reduced stress was the most frequently mentioned perceived benefit. Other major advantages related to feeling calmer, more focused, more self-aware, and improved health, consistent with much of the literature on the actual effects of meditation.26 Although many participants felt that there were no disadvantages to meditating and that no one would disapprove of them meditating, several challenges were identified. Time was the greatest concern, reflected in both the consequences and circumstances listed. Yet participants also provided several ideas for how limited time and other obstacles could be overcome, such as scheduling a regular time to meditate. 366
Offering strategies to overcome barriers has been found in other elicitations37 and can provide insight into what recommendations participants consider feasible. Concerns about meditating included having an appropriate space; not knowing how to meditate; not attaining the benefits or getting distracted when meditating; and not feeling supported by others or getting made fun of. Many referents were considered supportive of meditation, particularly family and friends. However, some participants indicated that family members and people within religious institutions might disapprove of meditation. These findings on salient beliefs have implications at individual, interpersonal, and organizational levels.28,38 At the individual and interpersonal levels, perceived advantages could be emphasized through a basic communication campaign that promotes meditation as a technique that can result in stress reduction and enhanced health. Because the most apparent obstacle to meditating was time, appealing to people’s desire to use their time more effectively and emphasizing the advantages identified such as improved focus and productivity could be useful. Many participants reported needing guidance, not knowing how to meditate, or concern that meditating will not have the intended effect. Developing or promoting innovative methods to teach people how to meditate, such as Web-based teaching tools and social media tips that help people to gain self-efficacy in their practice, may prove helpful. Learning could also occur in a group forum for meditation, particularly given that many participants sought someone else to meditate with. Supportive referents could be drawn upon by suggesting individuals practice with a friend or coworker, or calling attention to making a family member proud by taking care of oneself. Unease about getting distracted during meditation or not immediately seeing the benefits may hinder people from continuing meditation practice, which could be proactively acknowledged by meditation instructors along with the provision of strategies to overcome these concerns in case people face these challenges. The findings on salient beliefs likewise show that institutions can also institute changes to make the environment more conducive to meditation. Given that many participants felt that they lacked a quiet space and strategized about making meditation a part of their schedule given time constraints, offering regular meditation sessions at convenient locations and times on campus would help to overcome these barriers. Physical spaces on campus dedicated to meditation practice and other quiet activities throughout the day could also be provided and promoted. Supervisors, instructors, and other campus leaders could also consider giving a set time during meetings, classes, or other activities for brief meditation. Changing social norms may also reduce barriers to meditating given concerns about being made fun of and not feeling supported. One way of normalizing meditation at the institutional level could be through public testimonials of opinion leaders (ie, individuals who are respected and listened to by others on campus such as JOURNAL OF AMERICAN COLLEGE HEALTH
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leaders in student, faculty, and staff organizations and committees depending on the campus context).39 Further, religious institutions, particularly churches, have been found to be an influential source of support for various health issues,40,41 and if willing, individuals involved in these entities and on-campus faith communities could be a valuable resource for improving perceptions and promoting or even offering meditation programs.
Recommendations for Future Research As recommended for theory- and research-based intervention design, this study identified the salient beliefs underlying the decision to meditate on a regular basis. As a next step, these findings need to be followed by a survey with a larger, more representative sample using a closedended instrument based on the findings from this openended study. More specifically, the instrument should assess the detailed belief structure with 2 closed-ended items for each salient consequence (ie, behavioral belief about the likelihood that the consequence will follow from the action and outcome evaluation about how positive or negative the outcome is perceived to be), 2 items for each salient referent (ie, the normative belief about what the salient referent thinks the participant should do and the motivation to comply with that referent), and 2 items for each salient circumstance (ie, the control belief about the likelihood that the factor will be present and the perceived power of that factor on the action).27 Analyses of these data would allow intervention designers to identify the beliefs more strongly associated with intention and to prioritize intervention components. Given that the beliefs most strongly associated with intention might differ by type of university affiliation, it is recommended that the sampling frame for the larger study contain sufficient numbers of students, faculty, and staff to allow a quantitative comparison of these 3 groups. Findings of elicitations are specific to the communities in which they are conducted.27 Thus, it would be useful for studies similar to the one presented here to be done at different universities and in other settings to see if these findings can be replicated or the ways in which they differ. Additionally, 85.4% of participants had tried meditating at some point, yet only 35.4% reported meditating at least once in the past 7 days. This suggests that although many people are open to trying meditation, most initial meditation efforts do not transition into a consistent practice. It would be worthwhile to better understand not just what influences meditation practice, but also what factors underlie maintaining a regular meditation practice once initiated. Implementing institutional changes to make environments more conducive to meditation involves understanding the attitudes and behaviors of change agents. Additional research with college health professionals and other actors in the university organization on their beliefs VOL 62, AUGUST/SEPTEMBER 2014
about offering meditation programs and about providing spaces for meditation would be valuable. Although the definition for meditation provided in this study was intentionally broad, there was not a standardized definition in the literature to consider. As others have proposed,25,26,42 it may be helpful for researchers to develop and use a more uniform definition of meditation, at least among subsets of studies in which findings will be compared. Further, the literature does not provide a clear recommendation for how often individuals should meditate for optimal effects.26 This made selecting the frequency of meditation practice for this study challenging. When working to change behavior, people need to know not just what they should do, but how often they should do it. Thus, additional research should be conducted so that college health and other professionals know exactly what they should recommend in terms of frequency of meditation practice.
Limitations This study is not without limitations. Because the findings are specific to 1 institution, they may not be transferable to other populations. Also, although a small sample size is appropriate for a salient belief elicitation,27 the study used a convenience sample of self-selected individuals that was disproportionately female, was not racially/ethnically diverse, and included people particularly invested in wellness. The sample size did not permit separate analyses based on participant characteristics such as status within the university, and findings may therefore be more reflective of students’ beliefs than those of faculty and staff. Finally, although the instrument used previously established procedures for developing RAA measures27 and was pilot tested, it did not undergo additional validity tests.
Conclusion This was the first study to use the RAA to identify beliefs about meditating at least once a week. Although the benefits of meditation are plentiful, they can only be realized if college health professionals address the factors that influence university constituents’ decisions to meditate. This study was able to identify the underlying belief structure of meditation practice among campus members and provide tangible evidence-based recommendations to help college health professionals encourage meditation practice on their campuses. In doing so, this should lead to improved health and productivity among university students, faculty, and staff. FUNDING No funding was used to support this research and/or the preparation of the manuscript. 367
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CONFLICT OF INTEREST DISCLOSURE The authors have no conflicts of interest to report. The authors confirm that the research presented in this article met the ethical guidelines, including adherence to the legal requirements, of the United States and received approval from the Indiana University Institutional Review Board.
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NOTE For comments and further information, address correspondence to Alyssa M. Lederer, Department of Applied Health Science, Indiana University School of Public Health– Bloomington 1025 E. 7th Street, SPH 116, Bloomington, IN 47405-7109, USA (e-mail: [email protected]). REFERENCES 1. American College Health Association. American College Health Association–National College Health Assessment II: Reference Group Executive Summary Spring 2011. Hanover, MD: American College Health Association; 2011. 2. Hurtado S, Eagan MK, Pryor JH, Whang H, Tran S. Undergraduate Teaching Faculty: The 2010–2011 HERI Faculty Survey. Los Angeles: Higher Education Research Institute, University of California–Los Angeles; 2012. 3. Cohen S, Janicki-Deverts D, Miller GE. Psychological stress and disease. JAMA. 2007;298:1685–1687. 4. American Psychological Association. Stress in America: our health at risk. Available at: http://www.apa.org/news/press/ releases/stress/2011/final-2011.pdf. Published 2012. Accessed September 1, 2012. 5. Khubchandani J, Nagy MC, Watkins CM, Nagy S, Balls JE. A preliminary survey of university employee’s perceptions of work related stress: association with diet and exercise on campus. Am J Health Stud. 2009;24:306–313. 6. American College Health Association Faculty and Staff Health and Wellness Coalition. Best practices in faculty and staff health and wellness. Oral presentation at the American College Health Association Annual Meeting; Phoenix, AZ; June 3, 2011. 7. Emory University Faculty Staff Assistance Program. 2011 Health and Wellness Survey results. Available at: http://www. apa.org/news/press/releases/stress/index.aspx. Published 2012. Accessed September 1, 2012. 8. Goetzel RZ, Ozminkowski RJ. The health and cost benefits of work site health- promotion programs. Annu Rev Public Health. 2008;29:303–323. 9. Ford MT, Cerasoli CP, Higgins JA, Decesare AL. Relationship between psychological, physical, and behavioural health and work performance: a review and meta-analysis. Work Stress. 2011;25:185–204. 10. American College Health Association. Healthy Campus 2020. Available at: http://www.acha.org/HealthyCampus/. Published 2012. Accessed September 1, 2012. 11. National Center for Complementary and Alternative Medicine, National Institutes of Health. Meditation: an introduction. Available at: http://nccam.nih.gov/health/meditation/overview. htm. Published 2010. Accessed September 1, 2012. 12. Grossman P, Niemann L, Schmidt S, Walach H. Mindfulness-based stress reduction and health benefits: a meta-analysis. J Psychosom Res. 2004;57:35–43. 13. Chiesa A, Serretti A. Mindfulness-based stress reduction for stress management in healthy people: a review and meta-analysis. J Altern Complement Med. 2009;15:593–600. 14. Rosenzweig S, Reibel DK, Greeson JM, Brainard GC. Mindfulness-based stress reduction lowers psychological distress in medical students. Teach Learn Med. 2003;15:88–92. 368
15. Oman D, Shapiro SL, Thoresen CE, Plante TG, Flinders T. Meditation lowers stress and supports forgiveness among college students: a randomized controlled trial. J Am Coll Health. 2008; 56:569–578. 16. Travis F, Haaga DAF, Hagelin J, et al. Effects of transcendental meditation practice on brain functioning and stress reactivity in college students. Int J Psychophysiol. 2009;71:170–176. 17. Nidich SI, Rainforth MW, Haaga DAF, et al. A randomized controlled trial on effects of the transcendental meditation program on blood pressure, psychological distress, and coping in young adults. Am J Hypertens. 2009;22:1326–1331. 18. Alexander CN, Swanson GC, Rainforth MV, Carlisle TW, Todd CC, Oates RM. Effects of the transcendental meditation program on stress reduction, health, and employee development: a prospective study in two occupational settings. Anxiety Stress Coping. 1993;6:245–262. 19. Geary C, Rosenthal SL. Sustained impact of MBSR on stress, well-being, and daily spiritual experiences for 1 year in academic health care employees. J Altern Complement Med. 2011;17:939–944. 20. Beauchemin J, Hutchins TL, Patterson F. Mindfulness meditation may lessen anxiety, promote social sills, and improve academic performance among adolescents with learning disabilities. J Evid Based Complement Altern Med. 2008;13:134–145. 21. Nidich S, Mjasiri S, Nidich R, et al. Academic achievement and transcendental meditation: a study with at-risk urban middle school students. Education. 2011;131:556–564. 22. Paul G, Elam B, Verhulst SJ. A longitudinal study of students’ perceptions of using deep breathing meditation to reduce testing stresses. Teach Learn Med. 2007;19:287–292. 23. Shapiro SL, Brown KW, Astin J. Toward the integration of meditation into higher education: a review of research evidence. Teachers Coll Rec. 2011;113:493–528. 24. Robroek S, van Lenthe F, van Empelen P, Burdorf A. Determinants of participation in worksite health promotion programmes: a systematic review. Int J Behav Nutr Phys Act. 2009;6:Article 26. 25. Caspi O, Burleson KO. Methodological challenges in meditation research. Adv Mind Body Med. 2005;21:4–11. 26. Ospina MB, Bond TK, Karkhaneh M, et al. Meditation Practices for Health: State of the Research. Rockville, MD: Agency for Healthcare Research and Quality. AHRQ Publication No. 07-E010. Available at: http://www.mentalhealthwatch.org/ reports/meditation.pdf. Published 2007. Accessed September 1, 2012. 27. Fishbein M, Ajzen I. Predicting and Changing Behavior. New York, NY: Psychology Press; 2010. 28. Bartholomew LK, Parcel GS, Kok G, Gottlieb NH, Fernandez ME. Planning Health Promotion Programs: An Intervention Mapping Approach. 3rd ed. San Francisco, CA: Jossey-Bass; 2011. 29. American College Health Association. Standards for Practice for Health Promotion In Higher Education. 3rd ed. Hanover, MD: Author; 2012. 30. Middlestadt SE, Bhattcharyya K, Rosenbaum J, Fishbein M, Shepherd M. The use of theory-based semi-structured elicitation questionnaires: formative research for CDC’s prevention marketing initiative. Public Health Rep. 1996;111(suppl 1): 18–27. 31. Tabachnick BG, Fidell LS. Using Multivariate Statistics. 5th ed. Boston, MA: Pearson Education; 2007. 32. Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics. 1977;33:159–174. 33. Glanz K, Rimer BK, Viswanath K. Health Behavior and Health Education: Theory, Research, and Practice. 4th ed. San Francisco, CA: Jossey-Bass; 2008. 34. Richardson KM, Rothstein HR. Effects of occupational stress management intervention programs: a meta-analysis. J Occup Health Psychol. 2008;13:69–93. 35. McEachan RRC, Conner M, Taylor NJ, Lawton RJ. Prospective prediction of health-related behaviours with the theory of JOURNAL OF AMERICAN COLLEGE HEALTH
Beliefs About Meditating Among University Constituents 40. Peterson J, Atwood JR, Yates B. Key elements for churchbased health promotion programs: outcome-based literature review. Public Health Nurs. 2002;19:401–411. 41. Campbell MK, Hudson MA, Renicow K, Blakeney N, Paxton A, Baskin M. Church-based health promotion interventions: evidence and lessons learned. Annu Rev Public Health. 2007;28:213–234. 42. Cardoso R, de Souza E, Camano L, Leite JR. Meditation in health: an operational definition. Brain Res Protocol. 2004; 14:58–60. Received: 27 February 2013 Revised: 13 February 2014 Accepted: 14 March 2014
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planned behaviour: a meta-analysis. Health Psychol Rev. 2011;5:97–144. 36. Eggleston B, Middlestadt SE, Lindeman A, McCormick B, Koceja D. Attending yoga classes: applying the theory of planned behavior. Int J Health Wellness Soc. 2011;1:37–47. 37. Middlestadt SE. Reasons for eating better and moving more: lessons learned about the salient belief elicitation. Ann Am Acad Polit Soc Sci. 2012;640:81–100. 38. McLeroy KR, Bibeau D, Steckler A, Glanz K. An ecological perspective on health promotion programs. Health Educ Q. 1988;15:351–377. 39. Valente TW, Davis RL. Accelerating the diffusion of innovations using opinion leaders. Ann Am Acad Polit Soc Sci. 1999;566:55–67.
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Journal of American College Health Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/vach20
Beliefs About Meditating Among University Students, Faculty, and Staff: A Theory-Based Salient Belief Elicitation a
a
Alyssa M. Lederer MPH, CHES & Susan E. Middlestadt PhD a
Department of Applied Health Science, Indiana University School of Public Health–Bloomington, Bloomington, Indiana Accepted author version posted online: 17 Apr 2014.Published online: 15 Aug 2014.
To cite this article: Alyssa M. Lederer MPH, CHES & Susan E. Middlestadt PhD (2014) Beliefs About Meditating Among University Students, Faculty, and Staff: A Theory-Based Salient Belief Elicitation, Journal of American College Health, 62:6, 360-369, DOI: 10.1080/07448481.2014.907296 To link to this article: http://dx.doi.org/10.1080/07448481.2014.907296
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JOURNAL OF AMERICAN COLLEGE HEALTH, VOL. 62, NO. 6
Major Article
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Beliefs About Meditating Among University Students, Faculty, and Staff: A Theory-Based Salient Belief Elicitation Alyssa M. Lederer, MPH, CHES; Susan E. Middlestadt, PhD
Abstract. Objective: Stress impacts college students, faculty, and staff alike. Although meditation has been found to decrease stress, it is an underutilized strategy. This study used the Reasoned Action Approach (RAA) to identify beliefs underlying university constituents’ decision to meditate. Participants: N D 96 students, faculty, and staff at a large midwestern university during spring 2012. Methods: A survey measured the RAA global constructs and elicited the beliefs underlying intention to meditate. Thematic and frequency analyses and multiple regression were performed. Results: Quantitative analyses showed that intention to meditate was significantly predicted (R2 D .632) by attitude, perceived norm, and perceived behavioral control. Qualitative analyses revealed advantages (eg, reduced stress; feeling calmer), disadvantages (eg, takes time; will not work), and facilitating circumstances (eg, having more time; having quiet space) of meditating. Conclusions: Results of this theory-based research suggest how college health professionals can encourage meditation practice through individual, interpersonal, and environmental interventions.
college students nationally, with 27.5% reporting that stress had negatively impacted their academic performance in the last 12 months.1 Although there is no equivalent widereaching survey for university employees, studies at individual campuses have shown that faculty and staff also report that stress leads to negative outcomes in their personal and professional lives,5–7 and literature has shown that stress and poor health negatively impact work performance.4,8,9 Given the problematic outcomes, Healthy Campus 2020 calls for college health professionals to help students and employees decrease their stress levels.10 Meditation is considered a mind–body practice within the sphere of complementary and alternative medicine (CAM). Although it originated in the East, meditation is increasingly recognized as a strategy to improve health and well-being in the United States.11 Meditation has been shown to improve mental and physical health and enhance quality of life.12,13 Further, meditation has been found to specifically reduce stress among college students14–17 and employees.18,19 Additionally, there is emerging evidence that meditation may have a positive impact on students’ academic outcomes.20–22 Although meditation programs are an emerging practice in higher education,23 many institutions struggle with recruitment and attendance (H. Zesiger, personal communication, July 26, 2012), as they have with other wellness programs.24 This is particularly problematic given that these programs can only be efficacious and cost-effective if attendance is sufficiently high. At the national level in 2007, only 9.4% of US adults reported practicing meditation at least once in the past 12 months,11 and it is likely that far fewer maintain a regular practice. Although the impact of meditation is well studied,25,26 little is known about the beliefs underlying individuals’ decisions to meditate. Since “it is at the level of beliefs that we obtain substantive information about the considerations
Keywords: beliefs, college students, employees, meditation, reasoned action approach
S
tress is a pervasive problem in American society, and university communities are no exception. In 2011, 53.1% of college students reported an above average level of stress,1 and university faculty reported persistent work-related and other stressors.2 Stress has been linked to increased smoking, lack of exercise and sleep, depression, cardiovascular disease, and decreased medication adherence.3,4 Further, stress is associated with problematic academic and work outcomes. Stress was identified as the number 1 impediment to academic success for Ms Lederer and Dr Middlestadt are with the Department of Applied Health Science at Indiana University School of Public Health–Bloomington in Bloomington, Indiana. Copyright Ó 2014 Taylor & Francis Group, LLC 360
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Beliefs About Meditating Among University Constituents
that lead people to perform, or not to perform, a given behavior,”27(p204) effective intervention design rests on understanding these determinants.28 Thus, if college health professionals want to increase the number of people who meditate, the factors that influence meditation practice must be determined. This study sought to identify the salient, top-of-the-mind beliefs held by university students, faculty, and staff about meditating at least once per week for the next 3 months. The study included all campus constituents given the emerging trend in college health to view all members of a college campus as a community.10,29 The study was based on the Reasoned Action Approach (RAA), which has been used successfully to investigate decision making for a variety of behaviors.27 According to the RAA, behavior is principally determined by intention. Intention is, in turn, influenced by 3 global constructs: attitude towards the act, perceived norm, and perceived behavioral control, also known as self-efficacy. The 3 global constructs are grounded in underlying salient (top-of-the-mind) beliefs. Attitude is based on beliefs about the salient consequences of engaging in the behavior. Perceived norm is based on beliefs about what salient social referents (ie, people or social groups who have influence) think. Perceived behavioral control is influenced by beliefs about the salient circumstances that facilitate or hinder the behavior. A critical step in using the RAA to design interventions is an elicitation to identify salient consequences, referents, and circumstances that form the belief structure of the behavior.30 In this study, open-ended questions were asked of a sample of university students and employees to identify the most frequently mentioned beliefs about meditating at least once a week for the next 3 months. Because some studies have examined daily meditation and others have examined meditation once a week, the frequency of meditating at least once a week was selected for this initial study given the focus of ultimately encouraging people to begin a meditation practice. To the authors’ knowledge, this is the first study to explore the belief structure underlying deciding to meditate. METHODS A survey was conducted in spring 2012 with a convenience sample of students, faculty, and staff at a large midwestern public university.
Procedure The study was approved by the researchers’ institutional review board. Following the procedures developed and validated by Fishbein and Ajzen,27 the instrument developed for the study was piloted with 13 graduate students to confirm its timing, understandability, and feasibility. Minor revisions were made and the revised instrument was converted into the Web-based survey program Qualtrics (Provo, Utah). Students, faculty, and staff were recruited through e-mail requests, announcements in courses, wordVOL 62, AUGUST/SEPTEMBER 2014
of-mouth, and flyers at community locales frequented by university members (eg, coffee shops, restaurants). All recruitment materials provided a link to the online survey. No incentives were offered. Because a salient belief elicitation should consist of roughly equal numbers of participants who do and do not practice the behavior,30 recruitment efforts also targeted venues that were perceived as more likely to host people who meditate, such as a communitybased meditation center and yoga studios. To increase the sample size, a hard copy of the survey was distributed in an undergraduate health course. These data were then manually entered into Qualtrics. The only inclusion criteria were being 18 years or older and being a student, faculty, or staff member at the university.
Instrument The survey instrument began with an informed consent statement and consisted of 42 questions with 4 sections: (1) open-ended questions to elicit salient beliefs, (2) closedended questions measuring the RAA global constructs, (3) questions assessing meditation practice, and (4) items related to demographic and other participant characteristics. The survey took approximately 15 minutes to complete. The RAA variables were for the behavior of “meditating at least once per week for the next three months.” The behavior referred to meditation broadly given the subjective nature of meditation, its numerous forms, and in an effort to reach the widest possible audience. To ensure participants understood the study definition of meditation, the following description was provided: Meditation is generally seen as an inwardly oriented, personal practice, which individuals can do by themselves. Meditation refers to the actions involved in quieting the mind and body to allow one to become aware of the self. Meditation may involve cultivating a feeling or internal state or attending to a specific focal point or following the breath. The term can refer to the state itself as well as to practices or techniques employed to cultivate the state. Meditation can take various forms, including mindfulness, transcendental, movement, mantra, and spiritual meditation. For some, meditation is a religious or spiritual practice; for others it is a wellness practice.
Six open-ended questions elicited salient beliefs: 2 about consequences (ie, “What are the advantages or good things that might happen if you meditate at least once per week for the next three months?” and “What are the disadvantages or bad things that might happen. . .?”), 2 about social referents (ie, “Who, which people or groups, might approve or support you if you meditate at least once per week for the next three months?” and “Who, which people or groups, might disapprove . . .?”), and 2 about circumstances (ie, “What might make it easier for you to meditate at least once per week for the next three months?” and “What might make it hard for you . . .?”). Participants were asked to list 1 to 3 salient, top-of-the-mind responses for each question. 361
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Closed-ended RAA constructs were assessed with items using 7-point semantic differential or agree/disagree response options. Two items measured intention: (1) “My meditating at least once a week for the next three months is [likely/unlikely]” and (2) “I will meditate at least once a week for the next three months [strongly agree/strongly disagree].” Attitude was assessed by 4 items: “My meditating at least once a week for the next three months is [(1) good/bad; (2) enjoyable/unenjoyable; (3) wise/foolish; (4) pleasant/unpleasant].” Perceived norm was assessed with 3 items: (1) “Most people who are important to me think I should meditate at least once a week for the next three months [strongly agree/strongly disagree]”; (2) “Most people like me will meditate at least once a week for the next three months [strongly agree/strongly disagree]”; and (3) “How many people similar to you meditate at least once a week? [virtually all/almost none].” Perceived behavioral control was measured with 3 items: (1) “My meditating at least once a week for the next three months is [under my control/not under my control]”; (2) “How confident are you that you can meditate at least once a week for the next three months? [completely confident/not at all confident]”; and (3) “How sure are you that you can meditate at least once a week for the next three months? [very sure/not at all sure].”
Analysis Qualtrics data were exported into SPSS version 19.0 (IBM, Armonk, New York). Four cases were dropped because of missing quantitative data for the RAA constructs. The closed-ended items measuring the global constructs were recoded from 1 to 7 to ¡3 to C3. Reliability analyses confirmed a 2-item measure of intention (Cronbach’s a D .941), a 4-item measure of attitude (a D .911), a 3-item measure for perceived norm (a D .704), and a 3-item measure for perceived behavioral control (a D .783). The items for intention, attitude, perceived norm, and perceived behavioral control were then averaged to create a combined scale for each construct. Standard multiple regression analysis predicted intention from the 3 global constructs. Evaluating the assumptions of regression, including adequate sample size, normality, linearity, homoscedasticity of residuals, absence of outliers, and absence of singularity and multicollinearity31 resulted in deleting 1 case that was identified as a univariate outlier. At this point, all of the assumptions of regression were met. A content analysis was conducted of the responses to the open-ended questions to create categories of similar responses. Responses were reviewed verbatim and grouped by consequences (advantages and disadvantages of meditation), referents (people who approve and disapprove of meditation), and circumstances (what makes it easy and hard to meditate).30 Individual responses were listed within each category, and those that were conceptually similar were combined by A. M. L. (first author) who has 2 years of experience using the RAA and several years of 362
experience with qualitative analysis. S. E. M. (second author), who has over 30 years of experience with theorydriven research and qualitative coding, then reviewed the analyses and any areas of disagreement were discussed until consensus was reached. Responses within each category were listed in the order of the most common responses and each category was then labeled in the words of the participants. The data in the form of mentioned/not mentioned variables for each of the thematic categories were merged with the closed-ended data and frequency analyses were conducted to determine the most salient categories. Interrater agreement with a third researcher trained in the RAA using the kappa statistic was used to assess the reliability of the coding. More specifically, responses to all 6 questions, representing 25% of the cases and 369 individual responses selected at random, were coded by a second researcher familiar with conducting an RAA elicitation. The resultant kappa of 0.910 indicated a high level of agreement.32 RESULTS Participants The final sample size was N D 96, which included 72 participants from the online survey and 24 participants from the hard copy survey. As shown in Table 1, there was representation from diverse realms of university life, including undergraduate students, graduate students, faculty, and staff members. Most participants were under the age of 34 and identified as Caucasian. The vast majority reported a high level of concern with wellness and most were moderately or slightly spiritual.
Predisposition to Meditate Although 85.4% (n D 82) of participants had tried meditating at some point in their lives, 35.4% (n D 14) reported meditating at least once in the 7 days prior to the survey. From Table 2, it can be seen that although the participants had a positive attitude toward meditating at least once a week (M D 1.77 on a ¡3 to C3 scale), overall their intention was neutral (M D ¡0.182), showing neither a negative nor a positive intention to meditate. Perceived behavioral control was slightly positive (M D 0.903), whereas perceived norm was slightly negative (M D ¡0.361). Predicting Intention to Meditate As shown in Table 3, each global construct (attitude, perceived norm, and perceived behavioral control) had a moderate positive bivariate Pearson correlation (p < .001) with intention to meditate at least once per week for the next 3 months. The combination of the 3 global constructs significantly predicted intention to meditate (F[3, 95] D 52.692, p < .001). An R2 of .632 means that the 3 global constructs account for 63.2% of the variance in intention. All 3 constructs had statistically significant regression weights with perceived behavioral control making the largest JOURNAL OF AMERICAN COLLEGE HEALTH
Beliefs About Meditating Among University Constituents
contribution (b D .471, p < .001), then attitude (b D .354, p < .001), and then perceived norm (b D .191, p < .05).
TABLE 1. Participant Characteristics
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Characteristic University status Undergraduate Graduate Faculty Staff Sex Female Male Race/Ethnicity White/Caucasian Black or African American Latino or Hispanic Asian or Asian American Multiracial Other Age 18–24 25–34 35–44 45–54 55C Spirituality Very Moderately Slightly Not at all Concerned with wellness Very Moderately Slightly Not at all Meditation experience Ever tried In last 7 days
n
%
42 29 9 15
44.3 30.6 9.8 15.8
67 27
71.3 28.7
79 5 2 3 2 3
84.0 5.3 2.1 3.2 2.1 3.2
38 26 12 10 9
40.0 27.0 12.6 10.5 9.5
18 41 24 12
18.9 43.8 25.3 12.6
45 40 8 2
47.4 42.1 8.4 2.1
82 14
85.4 35.4
Salient Consequences Underlying Attitude Component Table 4 shows the salient, top-of-the-mind consequences, both positive and negative, about meditating at least once per week for the next 3 months. The most common advantage given was will reduce my stress (59.4%, n D 57), with responses such as “less stress” and “less anxiety.” This was followed by will make me calmer (50.0%, n D 48), which included responses such as “more calm,” “relaxation,” and “more peaceful.” Next was will make me more focused (39.6%, n D 38), which related to having more focus, having a clearer mind, and increased productivity. For example, 1 participant wrote “help you work more efficiently.” Participants also felt that meditating would make them more self-aware (30.2%, n D 29), with responses such as “know myself better” and “gain insights.” Participants also believed that meditation would improve my health (27.1%, n D 26). Although in most cases participants referred to health in general (eg, “better health”), some participants mentioned specific health outcomes (eg, “lower blood pressure,” “better sleep,” and “breathe better”). The most common disadvantage was it will take time (53.1%, n D 51). Many participants (31.3%, n D 30) were concerned that meditation will not work, giving answers such as “no actual benefits” and “frustration over lack of results.” Some participants believed that it was possible they will get too into it (10.4%, n D 10) or will get made fun of (9.4%, n D 9). A few participants were concerned it will make me think about uncomfortable things (7.3%, n D 7), such as “confront disturbing memories,” or that meditation could change the type of person I am (7.3%, n D 7), such as “inflated sense of self-importance.” Thirty
Note. Because some participants did not answer all questions, n does not add to 96 for every characteristic.
TABLE 2. Global Construct Scale Characteristics (N D 96) Scale
Items
a
M
SD
2 4 3 3
0.941 0.911 0.704 0.783
¡0.182 1.766 ¡0.361 0.903
2.01 1.23 1.28 1.58
Intention Attitude Perceived norm Perceived behavioral control
TABLE 3. Predictors of Intention to Meditate at Least Once per Week for the Next 3 Months (N D 96) Predictor variable Attitude Perceived norm Perceived behavioral control
Pearson r ***
.575 .601*** .666***
B
SE B
b
p
0.575 0.300 0.600
0.117 0.126 0.094
0.354 0.191 0.471
< 0.001*** 0.02* < 0.001***
Note. R2 D .632. * p < .05; **p < .01; ***p < .001.
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TABLE 4. Salient Consequences of Meditating at Least Once per Week for the Next 3 Months
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Consequence Advantages Meditating at least once per week for the next 3 months . . . (N D 96) Will reduce my stress Will make me calmer Will make me more focused Will make me more self-aware Will improve my health Will make me happier Will give me balance Will give me more patience Disadvantages Meditating at least once per week for the next 3 months . . . (N D 96) Will take time Will not work Will get too into it Will get made fun of Will make me think about uncomfortable things Will change the type of person I am None
n
%
57 48 38 29 26 15 13 11
59.4 50.0 39.6 30.2 27.1 15.6 13.5 11.5
51 30 10 9 7 7 29
53.1 31.3 10.4 9.4 7.3 7.3 30.2
Note. Percentages sum to more than 100%, since participants could list multiple answers.
percent of participants either wrote that there were no disadvantages to meditating or listed no disadvantages. Salient Circumstances Underlying Control Component Table 5 lists the salient, top-of-the-mind facilitators and barriers of meditating with the facilitator phrasing on the left and the barrier phrasing on the right. Time was the most frequently mentioned circumstance: 50% (n D 48) mentioned having more time as a facilitator and 83.3% (n D 80) said that having other things to do was a barrier. “Not enough time” and “busy schedule” were typical responses. Many were concerned with having a place to
meditate. About one-third of participants mentioned that having a quiet place would make meditation easier; about one-third indicated that not having a quiet place would make meditation more difficult. Some participants provided tactics for overcoming this barrier. For example, one participant suggested “the option of locking the office door, or study room door.” Participants felt that having guidance (27.1%, n D 26), which consisted of responses such as “training/education on how to meditate,” “learning how to do it,” and “guidance from someone” would help them to meditate. A few (9.4%, n D 9) mentioned not knowing how would make meditating more challenging. Not being able to relax (16.7%, n D 16)
TABLE 5. Salient Circumstances for Meditating at Least Once per Week for the Next 3 Months Salient circumstances Facilitators . . . makes it easier to me to meditate at least once per week for the next 3 months (N D 96) Having more time Having a quiet place Making it part of my schedule Having guidance Having people to do it with Practicing a specific technique Feeling supported Making a commitment Having patience Seeing the benefits
n
48 37 33 26 19 11 9 8 7 6
%
50.0 38.5 34.4 27.1 19.8 11.5 9.4 8.3 7.3 6.3
Barriers
n
%
. . . makes it difficult for me to meditate at least once per week for the next 3 months (N D 96) Having other things to do Not having a quiet space Having an irregular schedule Not knowing how
80 33 9 9
83.3 34.4 9.4 9.4
10 11 16 5 8
10.4 11.5 16.7 5.2 8.3
Not feeling supported Not being motivated Not being able to relax Not thinking it will work Having health problems
Note. Percentages sum to more than 100%, since participants could list multiple answers.
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was also an obstacle to meditation among participants, whereas 7.3% (n D 7) reported that having more patience would make meditating easier. Support or lack thereof was mentioned as a facilitator (9.4%, n D 9) and a barrier (10.4%, n D 10), respectively. Responses ranged from specific support systems such as “people at home who supported it” to wide-ranging social norms with responses such as “if it was socially normal.” Participants reported several overall strategies to facilitate their meditation practice, such as having people to do it with (19.8%, n D 19) and practicing a specific technique (11.5%, n D 11). Many participants (34.4%, n D 33) reported that making it part of my schedule would help them to meditate. This category included strategies like “setting a regular time,” “waking up earlier,” “time given in class,” and “time given at work.”
Salient Referents Underlying Normative Component As seen in Table 6, friends (52.1%, n D 50) and family (51.0%, n D 49) were the most frequently mentioned referents who would approve of meditating. Many participants listed family in general without reference to a specific family member. Several (19.8%, n D 19) thought that significant others, consisting of spouses, fiances, boyfriends, and girlfriends, would approve. People associated with various institutions (41.7%, n D 40) were also listed as approving of meditating. These included people affiliated with health care (16.7%, n D 16), which consisted of both medical and mental health professionals; religion (16.7%, n D 16), such as “Buddhists,” “religious leaders,” and “church”; university (9.4%, n D 9), which included faculty members, advisors, and coaches; and yoga (6.3%, n D 6) instructors and
practitioners. People who believe in meditation (15.6%, n D 15) were also thought to approve, with responses such as “other people who meditate” and “hippies.” The majority of participants (59.4%, n D 57) believed no one would disapprove of their meditating. Of those referents perceived as disapproving, family (13.5%, n D 13) and religion (10.4%, n D 10) were listed most frequently. COMMENT This study applied the RAA to identify the behavioral, normative, and control beliefs underlying university students’, faculty’s, and staff members’ decision to practice meditation at least once per week for the next 3 months. This research should prove valuable for 2 primary reasons. First, despite the evidence on the benefits of meditation, beliefs about meditating have not been investigated. The research presented begins to fill this gap. Second, this study was guided by a theory-based approach, which increases the likelihood that interventions developed using these findings will be successful.33 Although additional quantitative research with a larger sample is necessary to confirm these preliminary findings about beliefs about meditation, the results can provide a number of suggestions for interventions and programs to encourage meditation on college campuses and beyond. As such, recommendations for intervention design will be provided along with a discussion of the major findings below. The large majority of participants had tried meditation at least once and about one-third had meditated in the last 7 days. Participants had a positive attitude and somewhat positive sense of control over deciding to meditate, but their intention was neutral. This finding implies that meditation is a feasible intervention in this setting but efforts must be
TABLE 6. Salient Referents for Meditating at Least Once per Week for the Next 3 Months Salient referents Approving referents . . . approves of me meditating at least once per week for the next 3 months (N D 96) Significant other Family Family Sibling Parents Child Friends Coworkers People at institutions Health care Religion University Yoga People who believe in meditation
n
19 49 32 2 11 4 50 15 40 16 16 9 6 15
%
19.8 51.0 33.3 2.1 22.5 4.2 52.1 15.6 41.7 16.7 16.7 9.4 6.3 15.6
Disapproving referents
n
%
. . . disapproves of me meditating at least once per week for the next 3 months (N D 96) Significant other Family Family
3 13 7
3.1 13.5 7.0
Parents Child Friends Coworkers People at institutions Health care Religion University
3 4 6 4 13 2 10 1
3.1 4.2 6.3 4.2 13.5 2.1 10.4 1.0
People who don’t believe in meditation None
11 57
11.5 59.4
Note. Percentages sum to more than 100%, since participants could list multiple answers.
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made to increase individuals’ intention to meditate. Given this, campus health professionals should consider offering meditation programs for students, faculty, and staff, particularly with the forthcoming recommendations in mind. This programming should be practicable, as literature has shown that relaxation interventions such as meditation are one of the more easily implemented types of stress reduction programs that health promotion professionals can offer.34 Additionally, this collective approach may further efforts to cultivate a culture of health and community on campus. The R2 of 63.2% indicates that almost two-thirds of the variation in intention to meditate is explained by the 3 global constructs. This is somewhat larger than the average of 44.3% identified in a meta-analysis by McEachan and colleagues35 of over 200 studies related to multiple health behaviors. This finding demonstrates that the RAA is useful with this behavior for the campus population. Although all 3 global constructs had statistically significant regression weights, perceived behavioral control had the highest weight, then attitude, and the normative component weight was the lowest. This is somewhat consistent with the McEachen et al35 meta-analysis that found high mean regression weights for attitude (b D .35) and for perceived behavioral control (b D .34) and a low average weight for norm (b D .15). Interestingly, in a study using the theory of planned behavior to identify beliefs about yoga, another CAM practice, the same ranking of constructs was found as in the present study.36 The finding on the size of the weights implies that efforts to increase university constituents’ meditation practice should first focus on perceived behavioral control and then on attitude. Although the details on specific implications for practice require an analysis of specific beliefs and will be described in detail below, at this point, it should be noted that increasing a sense of control could be accomplished in 2 ways. On the one hand, college health professionals could make the campus environment more conducive to meditation through a variety of physical, social, organizational, and policy changes. On the other hand, professionals could also aid constituents in building their self-efficacy in order to overcome the barriers in the environment. The salient belief elicitation revealed the salient or topof-the-mind perceived consequences, circumstances, and referents that may influence university students and employees’ decision to meditate. Reduced stress was the most frequently mentioned perceived benefit. Other major advantages related to feeling calmer, more focused, more self-aware, and improved health, consistent with much of the literature on the actual effects of meditation.26 Although many participants felt that there were no disadvantages to meditating and that no one would disapprove of them meditating, several challenges were identified. Time was the greatest concern, reflected in both the consequences and circumstances listed. Yet participants also provided several ideas for how limited time and other obstacles could be overcome, such as scheduling a regular time to meditate. 366
Offering strategies to overcome barriers has been found in other elicitations37 and can provide insight into what recommendations participants consider feasible. Concerns about meditating included having an appropriate space; not knowing how to meditate; not attaining the benefits or getting distracted when meditating; and not feeling supported by others or getting made fun of. Many referents were considered supportive of meditation, particularly family and friends. However, some participants indicated that family members and people within religious institutions might disapprove of meditation. These findings on salient beliefs have implications at individual, interpersonal, and organizational levels.28,38 At the individual and interpersonal levels, perceived advantages could be emphasized through a basic communication campaign that promotes meditation as a technique that can result in stress reduction and enhanced health. Because the most apparent obstacle to meditating was time, appealing to people’s desire to use their time more effectively and emphasizing the advantages identified such as improved focus and productivity could be useful. Many participants reported needing guidance, not knowing how to meditate, or concern that meditating will not have the intended effect. Developing or promoting innovative methods to teach people how to meditate, such as Web-based teaching tools and social media tips that help people to gain self-efficacy in their practice, may prove helpful. Learning could also occur in a group forum for meditation, particularly given that many participants sought someone else to meditate with. Supportive referents could be drawn upon by suggesting individuals practice with a friend or coworker, or calling attention to making a family member proud by taking care of oneself. Unease about getting distracted during meditation or not immediately seeing the benefits may hinder people from continuing meditation practice, which could be proactively acknowledged by meditation instructors along with the provision of strategies to overcome these concerns in case people face these challenges. The findings on salient beliefs likewise show that institutions can also institute changes to make the environment more conducive to meditation. Given that many participants felt that they lacked a quiet space and strategized about making meditation a part of their schedule given time constraints, offering regular meditation sessions at convenient locations and times on campus would help to overcome these barriers. Physical spaces on campus dedicated to meditation practice and other quiet activities throughout the day could also be provided and promoted. Supervisors, instructors, and other campus leaders could also consider giving a set time during meetings, classes, or other activities for brief meditation. Changing social norms may also reduce barriers to meditating given concerns about being made fun of and not feeling supported. One way of normalizing meditation at the institutional level could be through public testimonials of opinion leaders (ie, individuals who are respected and listened to by others on campus such as JOURNAL OF AMERICAN COLLEGE HEALTH
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leaders in student, faculty, and staff organizations and committees depending on the campus context).39 Further, religious institutions, particularly churches, have been found to be an influential source of support for various health issues,40,41 and if willing, individuals involved in these entities and on-campus faith communities could be a valuable resource for improving perceptions and promoting or even offering meditation programs.
Recommendations for Future Research As recommended for theory- and research-based intervention design, this study identified the salient beliefs underlying the decision to meditate on a regular basis. As a next step, these findings need to be followed by a survey with a larger, more representative sample using a closedended instrument based on the findings from this openended study. More specifically, the instrument should assess the detailed belief structure with 2 closed-ended items for each salient consequence (ie, behavioral belief about the likelihood that the consequence will follow from the action and outcome evaluation about how positive or negative the outcome is perceived to be), 2 items for each salient referent (ie, the normative belief about what the salient referent thinks the participant should do and the motivation to comply with that referent), and 2 items for each salient circumstance (ie, the control belief about the likelihood that the factor will be present and the perceived power of that factor on the action).27 Analyses of these data would allow intervention designers to identify the beliefs more strongly associated with intention and to prioritize intervention components. Given that the beliefs most strongly associated with intention might differ by type of university affiliation, it is recommended that the sampling frame for the larger study contain sufficient numbers of students, faculty, and staff to allow a quantitative comparison of these 3 groups. Findings of elicitations are specific to the communities in which they are conducted.27 Thus, it would be useful for studies similar to the one presented here to be done at different universities and in other settings to see if these findings can be replicated or the ways in which they differ. Additionally, 85.4% of participants had tried meditating at some point, yet only 35.4% reported meditating at least once in the past 7 days. This suggests that although many people are open to trying meditation, most initial meditation efforts do not transition into a consistent practice. It would be worthwhile to better understand not just what influences meditation practice, but also what factors underlie maintaining a regular meditation practice once initiated. Implementing institutional changes to make environments more conducive to meditation involves understanding the attitudes and behaviors of change agents. Additional research with college health professionals and other actors in the university organization on their beliefs VOL 62, AUGUST/SEPTEMBER 2014
about offering meditation programs and about providing spaces for meditation would be valuable. Although the definition for meditation provided in this study was intentionally broad, there was not a standardized definition in the literature to consider. As others have proposed,25,26,42 it may be helpful for researchers to develop and use a more uniform definition of meditation, at least among subsets of studies in which findings will be compared. Further, the literature does not provide a clear recommendation for how often individuals should meditate for optimal effects.26 This made selecting the frequency of meditation practice for this study challenging. When working to change behavior, people need to know not just what they should do, but how often they should do it. Thus, additional research should be conducted so that college health and other professionals know exactly what they should recommend in terms of frequency of meditation practice.
Limitations This study is not without limitations. Because the findings are specific to 1 institution, they may not be transferable to other populations. Also, although a small sample size is appropriate for a salient belief elicitation,27 the study used a convenience sample of self-selected individuals that was disproportionately female, was not racially/ethnically diverse, and included people particularly invested in wellness. The sample size did not permit separate analyses based on participant characteristics such as status within the university, and findings may therefore be more reflective of students’ beliefs than those of faculty and staff. Finally, although the instrument used previously established procedures for developing RAA measures27 and was pilot tested, it did not undergo additional validity tests.
Conclusion This was the first study to use the RAA to identify beliefs about meditating at least once a week. Although the benefits of meditation are plentiful, they can only be realized if college health professionals address the factors that influence university constituents’ decisions to meditate. This study was able to identify the underlying belief structure of meditation practice among campus members and provide tangible evidence-based recommendations to help college health professionals encourage meditation practice on their campuses. In doing so, this should lead to improved health and productivity among university students, faculty, and staff. FUNDING No funding was used to support this research and/or the preparation of the manuscript. 367
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CONFLICT OF INTEREST DISCLOSURE The authors have no conflicts of interest to report. The authors confirm that the research presented in this article met the ethical guidelines, including adherence to the legal requirements, of the United States and received approval from the Indiana University Institutional Review Board.
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NOTE For comments and further information, address correspondence to Alyssa M. Lederer, Department of Applied Health Science, Indiana University School of Public Health– Bloomington 1025 E. 7th Street, SPH 116, Bloomington, IN 47405-7109, USA (e-mail: [email protected]). REFERENCES 1. American College Health Association. American College Health Association–National College Health Assessment II: Reference Group Executive Summary Spring 2011. Hanover, MD: American College Health Association; 2011. 2. Hurtado S, Eagan MK, Pryor JH, Whang H, Tran S. Undergraduate Teaching Faculty: The 2010–2011 HERI Faculty Survey. Los Angeles: Higher Education Research Institute, University of California–Los Angeles; 2012. 3. Cohen S, Janicki-Deverts D, Miller GE. Psychological stress and disease. JAMA. 2007;298:1685–1687. 4. American Psychological Association. Stress in America: our health at risk. Available at: http://www.apa.org/news/press/ releases/stress/2011/final-2011.pdf. Published 2012. Accessed September 1, 2012. 5. Khubchandani J, Nagy MC, Watkins CM, Nagy S, Balls JE. A preliminary survey of university employee’s perceptions of work related stress: association with diet and exercise on campus. Am J Health Stud. 2009;24:306–313. 6. American College Health Association Faculty and Staff Health and Wellness Coalition. Best practices in faculty and staff health and wellness. Oral presentation at the American College Health Association Annual Meeting; Phoenix, AZ; June 3, 2011. 7. Emory University Faculty Staff Assistance Program. 2011 Health and Wellness Survey results. Available at: http://www. apa.org/news/press/releases/stress/index.aspx. Published 2012. Accessed September 1, 2012. 8. Goetzel RZ, Ozminkowski RJ. The health and cost benefits of work site health- promotion programs. Annu Rev Public Health. 2008;29:303–323. 9. Ford MT, Cerasoli CP, Higgins JA, Decesare AL. Relationship between psychological, physical, and behavioural health and work performance: a review and meta-analysis. Work Stress. 2011;25:185–204. 10. American College Health Association. Healthy Campus 2020. Available at: http://www.acha.org/HealthyCampus/. Published 2012. Accessed September 1, 2012. 11. National Center for Complementary and Alternative Medicine, National Institutes of Health. Meditation: an introduction. Available at: http://nccam.nih.gov/health/meditation/overview. htm. Published 2010. Accessed September 1, 2012. 12. Grossman P, Niemann L, Schmidt S, Walach H. Mindfulness-based stress reduction and health benefits: a meta-analysis. J Psychosom Res. 2004;57:35–43. 13. Chiesa A, Serretti A. Mindfulness-based stress reduction for stress management in healthy people: a review and meta-analysis. J Altern Complement Med. 2009;15:593–600. 14. Rosenzweig S, Reibel DK, Greeson JM, Brainard GC. Mindfulness-based stress reduction lowers psychological distress in medical students. Teach Learn Med. 2003;15:88–92. 368
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